CN101516432B - Adaptive intracavitary brachytherapy applicator - Google Patents
Adaptive intracavitary brachytherapy applicator Download PDFInfo
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- CN101516432B CN101516432B CN2007800354502A CN200780035450A CN101516432B CN 101516432 B CN101516432 B CN 101516432B CN 2007800354502 A CN2007800354502 A CN 2007800354502A CN 200780035450 A CN200780035450 A CN 200780035450A CN 101516432 B CN101516432 B CN 101516432B
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Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N5/00—Radiation therapy
- A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
- A61N5/1001—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy using radiation sources introduced into or applied onto the body; brachytherapy
- A61N5/1007—Arrangements or means for the introduction of sources into the body
Abstract
The invention is a novel adaptive CT-friendly brachytherapy applicator with remotely-controlled radial and longitudinal motion radioactive source lumen shields that can be manipulated by the radiation oncologist to optimize the dose distribution to the target and normal tissue structures for brachytherapy procedures.
Description
Quoting of related application
The application requires the priority of U.S. Patent application 11/495027, and the applying date of this U.S. Patent application 11/495027 is on July 28th, 2006.
Technical field
The invention provides adapting to image a kind of novelty, that have remote control vagina insert keeper shielding part to obtain-compatible intracavitary brachytherapy (ICBT) applies device; It can be manipulated to the pseudo-shadow (artifacts) that reduces the X-ray computed tomography image; Perhaps optimize dose distribution, be used for cancer brachytherapy process target and normal structure structure.
Background technology
In 2003, the U.S. estimated to diagnose out above 12000 new cases of cervical cancer (American Cancer Society, Cancer Facts and Figures 2003).ICBT is the whole needed part of formation that is used for the cervical cancer therapeutic scheme.It also is used for the treatment of other gynecologic malignant tumor, for example cancer of vagina and carcinoma of endometrium.Generally speaking, these cancers have about 56000 new cases (American Cancer Society, Cancer Facts and Figures 2003) every year in the U.S., and wherein about 20% or 11200 case will be handled through ICBT and treat.In addition, in worldwide,, the gynecological cancer that develops into certain form above 600000 women there is every year according to the statistics of World Health Organization (WHO).
Usually, a lot of cervical cancers utilize X-ray therapy to treat.Between 1996 to 2000, in the U.S., the about 84% use LDR (LDR) in these treatments
137The Cs radioactive source, and remaining uses high dose rate (HDR)
192Ir (the Patterns of Radiotherapy Practice for Patients with Carcinoma of the Cervix 1996-1999:A Patterns-of-Care Study that people such as Eifel delivered among the Annual ASTRO Meeting of boundary at 2003 the 45th).A kind of mode that this radiation is provided is through the ICBT process.In the ICBT process, radioactive source manually or automatically is loaded into and is arranged in the endocervical device that applies through being called the back process of loading in operation process.Also can select or additional, ICBT can be before operation or operation carry out afterwards, and can match use with outer beam radiotherapy, chemotherapy or both.Usually, targeted cancerous cells or tissue shine through using brachytherapy to apply device.The current device that applies comprises left and right sides ovoid or the vagina insert keeper of being processed by rustless steel.These versions that apply device are designed for reducing because of the dedicated fixed tungsten shielding part that being not intended to radiation of rectum, bladder or other surrounding tissue is caused complication in addition.Currently be used to make shielding part to be positioned to depend on patient's anatomical tissue structure and surgical skill with bladder and the aligned operation of rectum.
In addition; The size of these shielding parts, shape, thickness and position will be near the normal structure of target focus (particularly; Under the situation of cervical cancer, being rectum) radiological dose that received has very big influence; And have been found that the dosage that the complication ratio directly depends on these organs and received.But the clinical treatment planning system of current use can not accurately be accomplished the effect of shielding part usually, thus cause 30% or too much expectation dosage be applied to error (people such as Mohan R, the Int J Radiat Oncol Biol Phys 1985a of vitals; 11 (4): 861-8.; People such as Mohan R, Int J Radiat Oncol Biol Phys 1985b; 11 (4): 823-30.; Weeks KJ, Med Phys 1998; 25 (12): 2288-92; Williamson JF, Int J Radiat Oncol Biol Phys 1990; 19 (1): 167-78).Other research shown because between the source shielding with apply dosage perturbation that device causes to clinical also of crucial importance, and should carry out modeling.People such as Fragoso find, in the LDR treatment, do not have that clearly the steel ovoid is applied the device modeling and will cause error up to 20% (people such as Fragoso M is at Proceedings of the 2003 AAPM Annual Meeting; In 2003).People such as Gifford infer that applying device for tandem carries out clear and definite modeling with extremely important.In the discovery source or between the source decay and exist nibbed screw that local dosed regions is had a significant effect (people such as Gifford K is at Proceedings of the 2003 AAPM Annual Meeting; In 2003).
Confirm that the whole ingredient by the target and the dose distribution of nontarget area reception is that any radiation barrier spare is positioned in the ovoid.ICBT dose distribution scheme be usually directed to use the target area and on every side the three-dimensional visualization of anatomical tissue structure confirm the correct position that applies device implanted so that make that the radiation dose distribution on the target area is maximum.In the past, for example having adopted computer tomography (CT), magnetic vibration isolation (MR) or positron emission tomography photography technology such as (PET) is that the ICBT process produces three-dimensional treatment plan.These technology receive the restriction of following factor: be used in ICBT apply in the device shielding part maybe since the image of distortion on position with cause the implant localization shadow and interfere with some method of planning, thereby cause being difficult to confirm to apply device in endoceliac optimum position.
United States Patent(USP) No. 5562594 discloses a kind of CT compatibility that can CT 3D dosimetry and has applied device design (" Weeks " apply device) (Weeks KJ and Montana CS, Int J Radiat Oncol Biol Phys 1997; 27 (2): 455-63).The Weeks ovoid has the tungsten shielding part source carrier of back dress after obtaining the CT image.The profile of Fleteher-Suit-Deelos (FSD) little vagina insert keeper tandem and ovoids system is shown as the shape basis that Weeks applies device.But fixedly Fletcher type shielding part is removed, and is replaced by the tungsten shielding part of packing into by hand with the 137Cs source.
Having utilized Weeks to apply device develops based on what improve CT and applies device location technology (Lerma FA and Williamson JF, Med Phys 2002; 29 (3): 325-33).This research confirms to support the 3D dose plan exactly, and this 3D dose plan relates to detailed 3D Monte Carlo Rapid Dose Calculation, modeling source positions, shield and apply between device and shield.But, Weeks applies some defectives of device existence.For example, Weeks applies device can not carry out long-range back dress (after insertion pack apply in the device and be positioned in the body cavity radioactive source), has therefore increased the radiation irradiation from the LDR brachytherapy; And it can not be used for the application of HDR or pulsed dosage ratio (PDR) at all.In addition, in order to hold back dress shielding part, it is much bigger that the volume ratio standard FSD that is connected to the arm of ovoid applies the arm of device.Increase feasible being difficult to of arm size the vagina binder is inserted, this vagina binder is used for bladder and rectum and radioactive source isolation.The volume that increases also maybe be with the comfortableness of patient when treating had potential negative effect.
" standard CT/MR applies device " that can commercial another selection that obtains be based on the Royal Marsden design of Nucletron Corporation.It is designed with the specific complex pipeline to eliminate the distortion of CT or MR image.In order to optimize dose distribution and to reduce mucosa dosage, this device that applies can have different length and ovoid diameters.But this applies device and is not designed to use with any shielding part, therefore uses it will cause rectum and bladder or other surrounding tissue to receive unnecessary high dose radiation irradiation, and this can cause clinical complication.
Therefore, need a kind of brachytherapy apply device, it can adapt to the radioactive source of back dress, and still can be operable under the minimum situation of the pseudo-shadow that makes generation and improve Image Acquisition.
Summary of the invention
The invention provides a kind of novel adaptive brachytherapy and apply device, but its Image Acquisition-compatibility, and comprise radially (rotation) and linear (translation) mobile shielding part of one or more remote controls.Thisly new apply device and can be used for LDR, PDR and/or HDR brachytherapy.Use some embodiment of the present invention to estimate to improve the clinical effectiveness of current brachytherapy, particularly through reducing the complication ratio.In such embodiment, in the image acquisition procedures of for example CT scan, the ability that changes screening-off position can be reduced to the pseudo-shadow of picture, thereby has increased the accuracy of describing important anatomy structure.In optional embodiment; ICBT applies device has one or more portable shielding spares; These portable shielding spares can provide the degree of freedom of increase, thereby can the multiimage guide treatment planning systems, so that optimize or change dose distribution according to the geometrical relationship of patient-apply device.In such embodiment, surgeon or user can follow the irradiation that reduces surrounding tissue (under the cervical cancer situation, being rectal wall and bladder) simultaneously with the dosage maximization of supplying with destination organization (for example cervix neoplasms).In comprising the embodiment of one or more shielding parts, shields motion criteria of the present invention (translation and rotation) will make that treatment can be based on the patient who derives from image aspects/apply device relativeness.This technology combines further to optimize use of the present invention with (in a few minutes) the fast dosage instrument that can accurately calculate shielding part dosage perturbation on every side.
Some embodiment of the present invention provides a kind of brachytherapy to apply device; It comprises radioactive source lumen, the shielding part that at least one is associated with this radioactive source lumen and the mechanical mechanism that is connected with this shielding part, and this mechanical mechanism can be with respect to radioactive source lumen moving along at least one direction control shielding part.
In other embodiments, brachytherapy of the present invention applies device and comprises: Pivot joint; Tandem with radioactive source lumen, wherein, this tandem is connected with Pivot joint through the tandem arm; At least one ovoid, this ovoid has radioactive source lumen, and wherein, this at least one ovoid is connected with Pivot joint through ovoid arm; And at least one shielding part, at least one ovoid of this shielding part and this is associated, wherein, and the remote-controlled motion of this at least one shielding part.In certain embodiments, brachytherapy applies device and also comprises: shield track, this shield track comprise this at least one shielding part, and wherein, this shielding part comprises gear interaction zone and reverse thread (Counter-treaded) parts; Rotating shaft, this rotating shaft have and the interactional related gear of the gear interaction zone of shielding part; And linear axes, this linear axes has threaded portion, and the reverse thread parts of this threaded portion and shield track interact.In other embodiments, brachytherapy applies device and also comprises: inner rotary part, this this at least one shielding part of inside rotary part supporting; And the outer buttons rotation member, this outer buttons rotation member and inner rotary part interact; And the single flexible axle, this single flexible axle has and the interactional related gear of outer buttons rotation member.Apply among some embodiment of device at brachytherapy of the present invention, radioactive source is housed after the radioactive source lumen.In comprising the embodiment of ovoid, radioactive source can come the back dress through ovoid arm.In some other embodiment, brachytherapy of the present invention applies device and also comprises: medicated cap, this cap sleeve is contained on the source capsule chamber.Some apply device and also comprise alignment mark, and this alignment mark is connected or is present in the medicated cap or on the medicated cap with the source capsule chamber.
In some optional embodiment, this at least one shielding part can surround the enclosure of radioactive source lumen, and in certain embodiments, shielding part is processed by tungsten or tungsten alloy.In optional embodiment, the motion of shielding part can be linearity or rotation mode.In certain embodiments, control through rotating shaft and to rotatablely move, control linear movement through linearity or longitudinal axis simultaneously.In other embodiments, rotatablely move and all control with linear movement through the single flexible rotating shaft.And in certain embodiments, arbitrary aforementioned axis can also be made up of Ni-Ti.
Some embodiment of the present invention can also comprise the man-operated mechanism that is used for applying to rotating shaft, longitudinal axis or flexible shaft revolving force.But, optional embodiment can comprise control station, and this control station control imposes on the revolving force of rotating shaft, longitudinal axis or flexible shaft.And in certain embodiments, brachytherapy applies the motion of the shielding part of device can be through the remote control of the remote measurement signal of telecommunication.In other embodiments, the position of shielding part can be confirmed through the feedback mechanism (for example optoelectronic component) that is used to confirm.
The present invention also provides a kind of method of treating tumor disease.These methods comprise: provide brachytherapy to apply device, the low coverage radiotherapy is applied device insert in the body cavity, in inserting body cavity, change the position that brachytherapy applies the shielding part of device afterwards then, shine tumor tissues subsequently.The optional embodiment of these methods also is included in the position of the Image Acquisition phasic change shielding part of treatment, so that change the image artifacts quality that causes owing to the existence that applies device.Another embodiment is included in the radioactive source brachytherapy of having packed into is changed the position of shielding part after applying in the device.In certain embodiments, change the position of shielding part so that change radiation dose distribution.
Description of drawings
Through explanation below in conjunction with accompanying drawing, can understand the present invention better, in the accompanying drawing, same reference numerals is represented similar elements, in the accompanying drawings:
Fig. 1 is the basic structure that brachytherapy applies device;
Fig. 2 has represented that brachytherapy applies device in the intravital position of patient;
Fig. 3 is the sketch map that brachytherapy applies an ovoid of device;
Fig. 4 A is the sketch map of the internal mechanism of brachytherapy with a self adaptation shielding part ovoid applying device;
Fig. 4 B is the sketch map of internal mechanism from seeing nearby that brachytherapy with self adaptation shielding part applies an ovoid of device;
Fig. 4 C has represented to have the connection of the rotating shaft of sleeve/shaft;
Fig. 4 D has represented to have the connection of the rotating shaft of flat side;
Fig. 4 E has represented to have the connection of the rotating shaft of spring;
Fig. 5 has represented the sketch map of shield track;
Fig. 6 A has represented the position of shielding part with respect to the internal mechanism of ovoid;
Fig. 6 B has schematically illustrated the position of shielding part with respect to the internal mechanism of ovoid;
Fig. 6 C is the sketch map of the internal mechanism of brachytherapy with the localized self adaptation shielding part of a single flexible axle capable of using ovoid applying device;
Fig. 6 D is the sketch map of optional embodiment of the internal mechanism of brachytherapy with the localized self adaptation shielding part of a single flexible axle capable of using ovoid applying device;
The cutaway view that Fig. 6 E schematically illustrates 6E ' from Fig. 6 C when seeing;
The cutaway view that Fig. 6 F schematically illustrates 6F ' from Fig. 6 C when seeing;
Fig. 6 G is the sketch map of optional embodiment of the internal mechanism of brachytherapy with two localized self adaptation shielding parts of a flexible shaft capable of using ovoid applying device;
Fig. 6 H is the sketch map of the internal mechanism of brachytherapy with localized self adaptation shielding part of a flexible shaft capable of using ovoid applying device, and this flexible shaft is directly installed on the shielding part or on the inner rotary part;
Fig. 6 I is the sketch map of the optional embodiment of brachytherapy with two localized self adaptation shielding parts of a flexible shaft capable of using ovoid applying device, and these two flexible shafts have pinion gear mechanism;
Fig. 6 J is the sketch map of the optional embodiment of brachytherapy with the localized self adaptation shielding part of a flexible shaft capable of using ovoid applying device, and this flexible shaft has the pinion gear mechanism that can slide in the ovoid internal linear;
Fig. 6 K is the sketch map of the optional embodiment of brachytherapy with the localized self adaptation shielding part of a flexible shaft capable of using ovoid applying device, and this flexible shaft has pinion gear mechanism;
Fig. 7 has represented the position of alignment metal wire in ovoid cap;
Fig. 8 represented to be used for brachytherapy apply device, based on the control unit of PC.
The specific embodiment
The invention provides a kind of novel adaptive brachytherapy and apply device; But its Image Acquisition-compatibility, and comprise and be arranged in radially (rotation) and linear (translation) mobile shielding part of one or more remote controls that ovoid (or vagina insert keeper), tandem or other comprise the structure of radioactive source lumen.The applying device and can be used for LDR, PDR and/or HDR brachytherapy of this novelty.Using some embodiment of the present invention to estimate will be particularly through reducing the clinical effectiveness that the complication ratio improves current ICBT.
The ability that in the image acquisition procedures of for example CT scan, changes any screening-off position can be reduced to the pseudo-shadow of picture, thereby can increase the accuracy of describing important anatomy structure.Improve the accuracy of target delineation and can regulate minimum target dosage and indication prescription isodose surface shape.In addition; Active shielding part can provide the degree of freedom of increase; Thereby make the multiimage guide treatment planning systems to optimize or to change dose distribution according to the geometrical relationship of patient-apply device; Therefore will supply with the dosage maximization of target disease tissue, and follow simultaneously to reduce the dosage that shielded tissue receives owing to shield.For example, when the treatment cervical cancer, to the dosage maximization of carcinoma, shielding part will reduce the radiological dose of rectal wall and bladder simultaneously.In certain embodiments, shields motion criteria of the present invention will make that treatment can be based on the patient who derives from image aspects/apply device relativeness.
In other embodiments, present technique combines further to optimize use of the present invention with (in a few minutes) the fast dosage instrument that can accurately calculate shielding part dosage perturbation on every side.Also can use real-time or precomputation Monte Carlo or discrete coordinates method at this moment.
According to the present invention remote-controlled moved shield is introduced in the brachytherapy device brachytherapy device applicable to most of type.For example, brachytherapy of the present invention capable of using applies device and treats gynecological cancer, division of chest disease's cancer, the brain cancer and neck cancer, the intestines and stomach cancer and breast carcinoma.Some embodiment of brachytherapy device of the present invention comprises: radioactive source lumen, and this radioactive source lumen can keep radioactive source; And shielding part, this shielding part is used for along the radiation that some direction reduces or obstruction is sent from radioactive source lumen.And these embodiment also comprise and are used for after will applying device insertion body cavity, guiding shielding part with respect to the localized mechanism of radioactive source lumen.These shielding parts that apply device can be in the inside of radioactive source lumen, perhaps can be in the outside of radioactive source lumen (ovoid shaft that for example applies in the device along FSD type brachytherapy is installed).Shielding part only need be arranged in radioactive source and will protect between the tissue regions that prevents to radiate.Some such embodiment can comprise a plurality of shielding parts.
In certain embodiments, shielding part can or bring and carry out with respect to the location of radioactive source or radioactive source lumen through the for example high torsional strength metal wire of mechanical mechanism.In such embodiment, the metal line or belt can extend to the position outside the patient body from applying device.In certain embodiments, the metal line or belt can be in the inside of the exterior tube that forms line/band-sheath type shaft.The metal line or belt can the oriented revolving force that it applies, so that to the position of shielding part Spin Control is provided.For example, gear mechanism can be connected with shielding part, so that Spin Control is provided.Also can select, the metal line or belt can be connected with screwed part, like this, applies revolving force to metal wire and will make the reverse thread that is installed on the shielding part carry out linear movement.In another optional embodiment, the metal line or belt can be connected with gear mechanism, and this gear mechanism is connected with the outer buttons rotation member.The outer buttons rotation member can further be connected with the inside rotary part of supporting shielding part, and this inside rotary part is connected with stationary threaded shaft again.When revolving force is applied on the metal line or belt, shielding part will rotate around this thread spindle, thereby produce linear translation and rotatablely move.Therefore, in certain embodiments shielding part can with radially or the mode of linear (or both) carry out Position Control.
Those of ordinary skills readily appreciate that, are used for the metal line or belt that position to shielding part applies control and can be any suitable architecture.For example, in certain embodiments, bar or post can be installed on the shielding part in (directly or indirectly), so that control linear movement or radial motion are perhaps controlled the two.In certain embodiments, band or metal wire (or bar) can be controlled linear movement, and simultaneously another band or metal wire (or bar) can be controlled radial motion.In another embodiment, band, metal wire or a bar can be controlled linearity and radial motion.
In certain embodiments, brachytherapy device also comprises locking mechanism, is fixed on correct position/orientation so that guarantee shielding part.Although in an embodiment also, for example use the closed loop feedback sensing device (passive or active) of optoelectronic component (comprising optical fiber, LED, light emitting diode etc.) to be used for providing the assurance of shield part position to the user.Some embodiment also comprise acquiescence " initially " position of shielding part, and it is confirmed based on current FSD ovoid concept.Optional embodiment of the present invention can be utilized the remote-control gear that links to each other with shielding part, and this remote-control gear does not extend to the proximal outer of patient body.In such embodiment, the position of shielding part can be controlled through external signal, and this external signal drives or discharges and apply the mechanical mechanism that device links to each other, so that the position of manipulation shielding part.This signal can be including, but not limited to radio wave, infrared ray and sound wave or other method of telemetering.
Fig. 1 has shown that FSD type ICBT of the present invention applies the structure of an embodiment of device.This embodiment that applies device comprises: tandem 2, and this tandem 2 is connected with Pivot joint 4 through tandem arm 2a; And a pair of vagina insert keeper/ovoid 3, this is connected with Pivot joint 4 through a pair of ovoid arm 5 vagina insert keeper/ovoid 3.In certain embodiments, 4 of Pivot joints are used to make pivot arm 2a to be connected with ovoid arm 5, and in some other embodiment, Pivot joint 4 not only plays the effect of junction point, can also change the angle between tandem arm 2a and ovoid arm 5.Tandem 2 is designed to when patient is shone, keep radioactive source with ovoid 3.In certain embodiments, tandem arm 2a and/or ovoid arm 5 can be used for making radioactive source to be respectively charged into tandem and ovoid through them.This can carry out in applying the processing that device is being called the back dress after being arranged in the body cavity.
Fig. 2 has shown that FSD type ICBT of the present invention applies device in the location when suffering from the patient of cervical cancer.During near ovoid 3 is positioned the cervix uteri outside intravaginal, tandem 2 is inserted in the uterus 7.
In the intracavitary brachytherapy process, can use FSD type embodiment of the present invention (as shown in Figure 1).Radioactive source can be arranged in tandem 2 and the ovoid 3, so that provide lucky surrounding target volumetrical pyriform dose distribution, its major axis is along tandem axis simultaneously.In certain embodiments of the present invention, radioactive source can be filled to later on and apply in the device.In some such embodiment, radioactive source inserts in the ovoid 3 through ovoid arm 5, and radioactive source is packed in the tandem 2 through tandem arm 2a.In this process before loading radioactive source; Applying device is usually located in the body cavity; And obtain image its position for confirmation; Quadrature x radiographic film, CT scan, MR scanning and/or PET scanning for example also can utilize these images to judge and checking applies device and carries out best located with respect to anatomical position and (offering the target area) radiological dose.
Fig. 3 provides the sketch map of the ovoid 3 that comprises rectal shield 9, bladder shield 10 and radioactive source lumen 11.These shielding parts can comprise arbitrarily such material, and this material will partially or completely be decayed and is transmitted to its radiation by radioactive source.The representative instance of this material is tungsten, tungsten alloy, titanium, platinum or other suitable high atomic number element.And shielding part can have various sizes, shape and thickness.Those skilled in the art will select size, shape and thickness according to the tissue that will treat, patient, radioactive source and other coherent element.In these embodiment of the present invention; Shielding part can exchange; Like this; Cure mainly oncologist and can select the shielding part of specific dimensions, shape and thickness, it will provide best shielding for the radioactive source of patient's anatomical structure, the target volume of describing, the key structure of describing, use or other factors.
In the treatment plan stage, calculating is used for non-destination organization (for example under the cervical cancer situation, being bladder and rectum) is carried out maximum appropriate location of protecting.Applying in the device of prior art, shielding part was fixed on permanent position usually before will installing the insertion body cavity, and perhaps shielding part offers with radioactive source usually and applies device (for example Weeks applies device).But, the invention discloses such device that applies, it comprises the mechanism that is used for this shield part position of adjusting after applying device (comprising shielding part) to insert body cavity.
Fig. 4 A has shown the sketch map of an embodiment of the ovoid of the present invention that comprises the adjustable positions shielding part.This shielding part can be positioned to protect non-destination organization, for example rectum or bladder (under the cervical cancer situation, being preferably rectum).This embodiment of the present invention comprises the ovoid cap 3a that surrounds radioactive source lumen 11.Ovoid cap 3a provides the housing that is used for shield track 12, and this shield track 12 links to each other with shielding part 9.Shield track 12 and shielding part 9 can be with respect to the central axis of ovoid 3 self with vertical or linear mode motions, and shielding part 9 also can move with radial manner with respect to the central axis of ovoid simultaneously.Shield track 12 can be on function and thread spindle 13, rotating shaft 14 or the two engagements.Thread spindle 13 can be included in its end or near the threaded portion 13a the end, and can make shield track 12 with respect to ovoid (as far as near) linear movement about in the of 3.Rotating shaft 14 can make shielding part 9 radially rotate with respect to the longitudinal center of ovoid 3.
In certain embodiments, rotating shaft or thread spindle can be by the metal line or belts of marmem (for example NiTi etc.) and are constituted, although also can use other material with high torsional strength.Also can select, rotating shaft or thread spindle can by knit wire or the braiding or solid high strength synthetic fibre silk make.
In certain embodiments, manual adjustments can be come with the mechanical interaction of shield track 12 or shielding part 9/10 respectively through thread spindle and/or rotating shaft 13/14 (shown in Fig. 4 A) in the position of shielding part 9.Shown in Fig. 4 B, the far-end of rotating shaft 14 or near the gear 16 that links to each other with this rotating shaft 14 can with shielding part 9/10 engagement, like this, the revolving force (moment) that imposes on rotating shaft 14 will make gear 16 make shielding part 9/10 radial motion.Similarly, the revolving force (moment) that imposes on thread spindle 13 can mesh with reverse thread housing 18 (as shown in Figure 5) (this reverse thread housing 18 links to each other with shield track 12), makes shield track 12 with respect to ovoid shaft 11a lengthwise movement.In certain embodiments, shield track can comprise mechanical stops, so that restriction shield track 12 can be moved the anglec of rotation of passing through with shielding part 9/10.
When shielding part 9 linear movements (near or far away), " rotating shaft " 14a can be in its pipe 14b slides within (being similar to the mode that can metal wire be pulled out from its insulating barrier), so that remain on the contact (shown in Fig. 4 C) between gear 16 and the shielding part 9.At (shown in Fig. 4 D) among the optional embodiment, can use rotating shaft with flat side 14c, this flat side 14c passes the remote extension of gear 16 towards ovoid cap 3a.In these embodiment, gear 16 can be with shielding part 9/10 and shield track 12 along rotating shaft 14 linear slide, so that keep the interaction of it and shielding part 9/10.In an embodiment also, the load on spring of rotating shaft 14d part can be used for keeping during along ovoid 3 linear movements in shield track the interaction (shown in Fig. 4 E) of gear 16 and shielding part 9/10.
The threaded portion of shield track 12, gear 16 or thread spindle 13 (" moving component ") can be made by any suitable material.In certain embodiments, the material that is used to make these moving components will be based on mechanical strength (stretch and shear), tissue radiation characteristic equivalent, fatigue and thermal characteristics, so that decontamination cycle repeatedly.In certain embodiments, these moving components are made by polysulfones or Merlon or other tissueequivalentmaterial, and these materials are compared and made the perturbation of dose distribution minimum with helping with the transitional device that applies.
Fig. 6 A provides the interior views of the ovoid 3 with shielding part 9/10, and has removed the shield track 12 shown in Fig. 4 B in order to know.In certain embodiments, rotating shaft 14 and thread spindle 13 can pass ovoid supporting member 17 and extend and supported by this ovoid supporting member 17, this ovoid supporting member 17 also with the shell engagement of radioactive source lumen 11a.In optional embodiment of the present invention, for example shown in Fig. 6 B, ovoid can be equipped with the thread spindle 13 and rotating shaft 14 that is used for a plurality of shielding parts 9/10.In such embodiment, can there be rectal shield 9, bladder shield 10 or the two, each shielding part that it self shield track 12 is independently all arranged.In some such embodiment, to compare with bladder shield 10, the shield track 12 that links to each other with rectal shield 9 can be more near the position of the far-end of ovoid 3.Such embodiment can make rectal shield 9 and bladder shield 10 independently radially and linear orientation.
Fig. 6 C and 6D have shown that brachytherapy applies the sketch map of an embodiment of internal mechanism of an ovoid of device, and this ovoid comprises single flexible axle 34 localized self adaptation shielding parts capable of using.Through using the single flexible axle, mechanism occupies ovoid inner space still less, and internal mechanism will be more durable.In Fig. 6 C and 6D, single flexible axle 34 can be connected with gear 36 through bearing 35.In certain embodiments, gear can be a pinion.In such embodiment, when flexible shaft 34 rotations, pinion 36 is equally with similar direction rotation.Shown in Fig. 6 F, the tooth on the pinion 36 again with outer buttons rotation member 38 on tooth 37 engagement; Like this, pinion 36 drives outer buttons rotation member 38.Outer buttons rotation member 38 is a cylindricality, and moves with radial manner with respect to the central axis of ovoid self.Outer buttons rotation member 38 has guide rail 39, and this guide rail 39 extends along the inwall of outer buttons rotation member 38.
In certain embodiments, inner rotary part 40 is included in the outer buttons rotation member 38, and on the axis identical with outer buttons rotation member 38, rotates.In these embodiment; When the guide rail on the outer buttons rotation member 38 39 when groove 41 on the inner rotary part 40 contacts; Outer buttons rotation member 38 interacts with inner rotary part 40, thereby makes inner rotary part 40 move with the direction identical with outer buttons rotation member 38 and rotating speed/angular velocity.Inner rotary part 40 supportings are used to protect the shielding part 42 of non-destination organization.The center of inner rotary part 40 comprise can with stationary threaded shaft 43 interactional screw threads.Therefore, when inner rotary part 40 during around stationary threaded shaft 43 rotation, inner rotary part 40 carries out lengthwise movement with respect to ovoid shaft and rotatablely move (stationary threaded shaft 34 promptly).Therefore, by the shielding part 42 of inner rotary part 40 supportings with respect to (as far as near) linear movement about the ovoid, and around the central axis radial motion of ovoid.
In certain embodiments, stationary threaded shaft 43 comprises mechanical stops 44, so that the fore-and-aft distance that restricted internal rotary part 40 can move.And; In certain embodiments; The screw thread that is used for inner rotary part 40 and stationary threaded shaft 43 will have very little thread pitch; Like this, the individual pen of inner rotary part 40 rotation can only make shielding part 42 along stationary threaded shaft 43 fore-and-aft distance of very little increment that moves, thus make shielding part 42 can be in ovoid accurate location.
In optional embodiment, the linear movement of inner rotary part 40 can be controlled by a flexible shaft 34, and radial motion is simultaneously controlled by another.For example, Fig. 6 G has represented such embodiment.
Fig. 6 E shows according to one embodiment of the invention at the inside rotary part 40 of supporting shielding part 42 and the sketch map of the relation between the outer buttons rotation member 38.As shown in the figure, outer buttons rotation member 38 is cylindricalitys, and comprises internal guide rail 39.Guide rail 39 interacts with the inside rotary part 40 of supporting shielding part 42.Stationary threaded shaft 43 interacts with the center of inner rotary part 40.Therefore, when outer buttons rotation member 38 during around the rotation of the axis at the center of vertically passing ovoid, this makes shielding part 42 rotate around same axis.Like this, shielding part 42 can radial location in ovoid.
In certain embodiments, flexible shaft 34 is by the metal line or belt of marmem (for example NiTi etc.) and constitute, although also can use other material with high torsional strength.Also can select, flexible shaft 34 can by knit wire or the braiding or solid high strength synthetic fibre silk make.Pinion 36, outer buttons rotation member 38, inner rotary part 40 or stationary threaded shaft 43 can be made by any suitable material.In certain embodiments, the material that is used to make these parts will be based on mechanical strength (stretch and shear), tissue radiation characteristic equivalent, fatigue and thermal characteristics, so that decontamination cycle repeatedly.In certain embodiments, these parts are made by polysulfones or Merlon or other tissueequivalentmaterial, and these materials are compared and made the perturbation of dose distribution minimum with helping with the transitional device that applies.
(for example shown in Fig. 6 G and the 6H) in another embodiment, the lengthwise position of shielding part is through being directly installed on bar, band or metal wire on the inner rotary part 40 or controlling on the shielding part.In such embodiment, inner rotary part can be through making bar, band or metal wire to the distant place or to motion nearby and along central axis (stationary threaded shaft 43 parts that for example do not have screw thread) longitudinal sliding motion.In certain embodiments, the radial position of shielding part can be through gear and Bearning mechanism and is regulated (for example seeing Fig. 6 I) by another metal wire, band or bar.In some such embodiment, gear mechanism is with inner rotary part 40 longitudinal sliding motions.For example, Fig. 6 I and 6J have represented the embodiment that some is such.In some such embodiment, flexible shaft 34 can be used for through being stretched by retainer spring 45 or discharging and to shielding part linear orientation (for example seeing Fig. 6 J) from this retainer spring 45.Those of ordinary skills should be known in that a flexible shaft 34 can be used to control linearity and radial location, perhaps also can select, and a flexible shaft 34 can be used to handle linear position, and another handles radial position.In optional embodiment; Gear mechanism and outer buttons rotation member 38 interact, and the promotion that this outer buttons rotation member 38 can produce through the interaction by the groove 41 on guide rail on the outer buttons rotation member 38 39 and the inner rotary part again makes inner rotary part 40 rotate.
Fig. 6 K has shown another embodiment with central shaft 46, and this central shaft 46 is by the single pinion radial drive (pinion and flexible shaft are not shown) that is connected with flexible shaft.Central shaft comprises external screw thread 47.Keep the dish 48 of shielding part to be threaded on the axle.Ridge 49 is static, and is installed on the external shell of ovoid.The internal friction power that is threaded enough, this internal friction power make dish 48 (and shielding parts) can not advance along this axle, only if apply certain force.Some embodiment comprises mechanical stops 50.Fig. 6 K (C) has represented sequence of motion: through making central shaft 46 rotations, shielding part can reach 360 degree in the rotation of the proximal end of ovoid.Then, shield stop 50 intersects with ridge 49.Then, make the far-end linear operation of shielding part through continuing rotary middle spindle towards ovoid.At far-end, the direction of rotation of central shaft 46 can be changed, thereby makes the shielding part rotation reach 360 degree.This order can repeat in opposite direction.And described in this application embodiment is an instance, the present invention includes to use some mechanism to be used for Linear Control, and other suitable mechanism is used for radially controlling (vice versa).
Optional embodiment can comprise a plurality of shielding parts, and wherein, one or more shielding parts can be fixed on its position with respect to radioactive source, and not with ovoid 3 in detent mechanism engagement.For example; In one embodiment; Bladder shield can be fixed on the ovoid shaft 11a, simultaneously rectal shield 9 can through swing pinion 16 and thread spindle 13, through reverse thread housing 18 with carry out position with linking to each other of shield track 12 through rotating shaft 14 through it and move.Also an embodiment can allow inverse structure, and wherein, bladder shield 10 is associated with shield track 12, and rectal shield will be fixed.
In certain embodiments, ovoid 3 can have dismountable ovoid cap 3a, and this ovoid cap 3a can dismantle from ovoid, so that expose shielding part and other moving component, thereby allows to carry out the quality assurance visual inspection or carries out corrective maintenance.In an embodiment also, ovoid cap 3a of the present invention self can self adaptation so that increase the overall dimension of ovoid 3, thereby with given patient's anatomical structure coupling.In some other embodiment; Self adaptation of the present invention applies device can be had and be similar to the overall profile of ovoid handle (nearside pipe) that current Nucletron Fletcher-Williamson HDR applies device equipment (about 5mm exterior tube diameter), so that seamless combination clinically is provided.And in other embodiments, self adaptation applies the profile of device can be bigger a little, so that hold the conduit (about 7mm exterior tube diameter) that is used for thread spindle and rotating shaft 13,14.
In certain embodiments, the longitudinal axis of ovoid is with respect to the adjustable angle joint of ovoid arm 5.In some such embodiment, angle can be regulated between 15 ° and 45 °.In other embodiments, metal wire/band can interact with gear driven mechanism, and this gear driven mechanism can remote control changes the shape or the size of shielding part.
And some embodiment of the present invention can comprise alignment mark.These alignment marks provide labelling in image acquisition procedures, this labelling makes shielding part can confirm or verify with respect to the position of differences in patient.These alignment marks can be made up of any radiopaque material, can be form of wires in certain embodiments.Alignment mark can be included in the various piece that applies device of the present invention or on the various piece, comprises radioactive source lumen, tandem or ovoid.Fig. 7 has represented to have an embodiment of the ovoid 3 of or the alignment metal wire 32 that tilt parallel with respect to ovoid.In such embodiment, alignment metal wire 32 can be angled with respect to the plane positioning that will obtain image segments 33.Other embodiments of the invention can have the alignment mark of various other structures.In certain embodiments, alignment mark can be associated with the default location of shielding part.In these embodiment, the image that obtains will have alignment mark, and this alignment mark will be confirmed the default location of shielding part directly or indirectly, therefore, can confirm to obtain the necessary shields motion in selected location of shielding part more accurately.
In certain embodiments, alignment mark can embed the shell that is used for radioactive source lumen or ovoid shaft 11a.In other embodiments, alignment mark can be arranged in ovoid 3 in medicated cap on one's body or on this medicated cap.
In certain embodiments, self adaptation of the present invention applies the Monte Carlo of device or the final selection that discrete coordinates dosimetry simulation can be used for confirming rectal shield, bladder shield or the two linearity/angular movement scope.And; The ability that the present invention upwards carries out internal regulation to the position of shielding part with the footpath in the vertical will allow shielding part in the process that CT Image Acquisition or other types of image are obtained, to move; Thereby the nurse can be reduced because brachytherapy applies the pseudo-shadow that shielding part produced in the device, and bigger precision is provided in treatment plan and improves the image that uses.For example, apply device and can insert in the body cavity, obtain image then, simultaneously shielding part moves to the position of nearside along ovoid axis.Like this, the single slice CT scanner will obtain the first picture group picture before the position that arrives moved shield.Then, the interrupt scanning appearance obtains tout court, so that before continuing to obtain all the other CT layers, make shields motion to the farthest side position.The initial detecting image of CT simulator can be used to be chosen in two interruption position between the image sets.Except catching improved image, some embodiment of the present invention can also carry out reverse treatment plan to therapeutic scheme.For example, radioactive source can be packed into when shielding part is in the precalculated position and applied in the device, in the radiating irradiation process, carries out shielding part location or shield part position then and regulates, so that with more accurate form control dose distribution.
In certain embodiments, the device that applies of the present invention can comprise the man-operated mechanism that is used on thread spindle 13, rotating shaft 14 or flexible shaft 34, applying revolving force.These man-operated mechanisms can comprise the simple and mechanical adnexa that is installed on the axle, for example are connected the screwdriver on the axle.In other embodiments, for simply, the rotation of rotating shaft, thread spindle or flexible shaft can utilize dial indicator to control.In such embodiment, each mechanical graduated disc can have scale, so that the position and the orientation of the shielding part that expression is regulated.And graduated disc can be designed for making things convenient for the surgeon approaching.In other embodiments, thread spindle 13, rotating shaft 14 or flexible shaft 34 are through hydraulic control.In such embodiment, it is outside that mechanism is positioned at ovoid inside or ovoid, so that hydraulic pressure is transformed into appropriate motion (promptly linear, rotation perhaps the two).
Optional embodiment of the present invention can use a computer 27 as control station.In some such embodiment; Hardware component can comprise having LabVIEW software 28 and PCI motion controller card 29 (from National Instruments; Austin, Texas (www.ni.com)) laptop computer and motor control driver element 30 with a plurality of axis.As shown in Figure 8, the position of shielding part can be controlled through control station 27.Control station can be controlled the position of rotation of given shielding part through Rotation Controllers 24, and can control the linear position of given shielding part through linear controller 25.In certain embodiments, rectal shield and bladder shield can have independently control station (23 and 23a).In certain embodiments, control station can be controlled the action of motor 22, and this motor 22 will provide the revolving force on rotating shaft, thread spindle or the flexible shaft.
In certain embodiments, control station or apply device self automatic guide position (default location) can be arranged, this automatic guide position simulation FSD applies device (being used for LDR) or Flecher-Williamson applies the device shield part position of (being used for HDR/PDR).
In certain embodiments; Control station can be used for packing into to apply at radioactive source shielding part being positioned at correct position before the device; Perhaps radioactive source can be packed into and applied in the device, and shielding part is in the precalculated position, in the radiating irradiation process, regulates shield part position subsequently; So that handle dose distribution with accurate way more, thereby make the pyriform prescription isodose surface of regulation consistent with the target volume of describing.Radiation biological correction dose volume block diagram treatment plan algorithm also can be used for further optimizing along therapeutic process the position of shielding part.
Claims (16)
1. a brachytherapy applies device, comprising:
Pivot joint;
Tandem, this tandem has radioactive source lumen, and wherein, this tandem is connected with Pivot joint through the tandem arm;
At least one ovoid, this ovoid has radioactive source lumen, and wherein, this at least one ovoid is connected with Pivot joint through ovoid arm;
At least one shielding part, at least one ovoid of this shielding part and this is associated, and wherein, this at least one shielding part is remote-controlled motion;
Stationary threaded shaft;
Inner rotary part, this this at least one shielding part of inside rotary part supporting, wherein, this inside rotary part is around this stationary threaded shaft rotation;
The outer buttons rotation member, this outer buttons rotation member is around this inside rotary part rotation; And
Flexible shaft, this flexible shaft has the gear that is associated, and gear that this is associated and outer buttons rotation member interact, and make inner rotary part rotate.
2. brachytherapy according to claim 1 applies device, wherein: the radioactive source lumen of this at least one ovoid can after radioactive source is housed.
3. brachytherapy according to claim 1 applies device, and wherein: radioactive source then is filled in the radioactive source lumen of said at least one ovoid through ovoid arm.
4. brachytherapy according to claim 1 applies device, and wherein: this at least one ovoid also comprises shell, and this at least one shielding part is in the inside of the shell of this at least one ovoid.
5. brachytherapy according to claim 1 applies device, and wherein: this at least one shielding part is made up of tungsten, tungsten alloy or other radiation absorption material.
6. brachytherapy according to claim 1 applies device, and wherein: flexible shaft is made up of Ni-Ti.
7. brachytherapy according to claim 1 applies device, also comprises: the man-operated mechanism that is used for applying to flexible shaft revolving force.
8. brachytherapy according to claim 1 applies device, also comprises: control station, this control station control imposes on the revolving force of flexible shaft.
9. a brachytherapy applies device, comprising:
At least one ovoid, this ovoid has radioactive source lumen, and said at least one ovoid is connected with ovoid arm;
At least one shielding part that is associated with this radioactive source lumen;
Support the inside rotary part of this at least one shielding part;
The outer buttons rotation member, this outer buttons rotation member rotates around inner rotary part, thereby makes inner rotary part rotation;
Flexible shaft, this flexible shaft has the gear that is associated, and gear that this is associated and outer buttons rotation member interact;
Wherein, when revolving force imposed on flexible shaft, this at least one shielding part moved along at least one direction with respect to radioactive source lumen.
10. brachytherapy according to claim 9 applies device, wherein: after the radioactive source lumen of this at least one ovoid radioactive source is housed.
11. brachytherapy according to claim 10 applies device, wherein: radioactive source then is filled in the radioactive source lumen through ovoid arm.
12. brachytherapy according to claim 9 applies device, wherein: this at least one ovoid also comprises shell, and this at least one shielding part is in the inside of the shell of this at least one ovoid.
13. brachytherapy according to claim 9 applies device, this at least one shielding part is made up of tungsten, tungsten alloy or other radiation absorption material.
14. brachytherapy according to claim 9 applies device, wherein: flexible shaft is made up of Ni-Ti.
15. brachytherapy according to claim 9 applies device, also comprises: the man-operated mechanism that is used for applying revolving force to flexible shaft.
16. brachytherapy according to claim 9 applies device, also comprises: control station, this control station control imposes on the revolving force of flexible shaft.
Applications Claiming Priority (3)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US11/495,027 | 2006-07-28 | ||
| US11/495,027 US7651458B2 (en) | 2004-07-20 | 2006-07-28 | Adaptive intracavitary brachytherapy applicator |
| PCT/US2007/016916 WO2008094199A2 (en) | 2006-07-28 | 2007-07-27 | Adaptive intracavitary brachytherapy applicator |
Publications (2)
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| CN101516432A CN101516432A (en) | 2009-08-26 |
| CN101516432B true CN101516432B (en) | 2012-11-07 |
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| WO2010011844A1 (en) * | 2008-07-25 | 2010-01-28 | Tufts Medical Center | A system and method of clinical treatment planning of complex, monte carlo-based brachytherapy dose distributions |
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| US9345907B2 (en) * | 2011-07-01 | 2016-05-24 | Mick Radio-Nuclear Instruments, Inc. | Bladder and/or rectum extender with exchangeable and/or slideable tungsten shield |
| US9099209B2 (en) * | 2011-07-01 | 2015-08-04 | Mick Radio-Nuclear Instruments, Inc. | Bladder and/or rectum extender with exchangeable and/or slideable tungsten shield |
| CN103702718A (en) * | 2011-07-27 | 2014-04-02 | 米克放射原子能设备公司 | Bladder and/or rectum extender with exchangeable and/or slideable tungsten shield |
| US8979725B2 (en) | 2012-05-23 | 2015-03-17 | Mark A. D'Andrea | Brachytherapy tandem and ovoid implantation devices and methods |
| US9149653B2 (en) | 2013-03-06 | 2015-10-06 | Mark A. D'Andrea | Brachytherapy devices and methods for therapeutic radiation procedures |
| US9192345B2 (en) | 2013-03-11 | 2015-11-24 | Mark A. D'Andrea | Radiation devices and methods |
| US9604074B2 (en) | 2013-03-15 | 2017-03-28 | Mark A. D'Andrea | Radiation treatment sheet devices and methods |
| CN104147688A (en) * | 2014-07-31 | 2014-11-19 | 吉林大学 | Rapidly-formed self-adaptive afterloading brachytherapy source applicator and manufacturing method thereof |
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| US10668299B2 (en) * | 2015-04-10 | 2020-06-02 | Nucletron Operations B.V. | Brachytherapy applicators having ultrasound elements |
| US10086213B2 (en) | 2015-04-23 | 2018-10-02 | Mark A. D'Andrea | Mobile gynecological balloon devices and methods |
| CN104874112B (en) * | 2015-05-21 | 2018-02-23 | 山东新华医疗器械股份有限公司 | Applicating device support |
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| US20180085598A1 (en) * | 2016-09-25 | 2018-03-29 | Jiaju Zhang | Brachytherapy Applicator |
| CN108732608B (en) * | 2018-05-15 | 2024-02-06 | 四川省肿瘤医院 | Post-loading quality control device and Monte Carlo simulation-based verification method thereof |
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| WO2006014701A2 (en) * | 2004-07-20 | 2006-02-09 | Board Of Regents, The University Of Texas System | Adaptive intracavitary brachytherapy applicator |
Also Published As
| Publication number | Publication date |
|---|---|
| EP2046438A2 (en) | 2009-04-15 |
| WO2008094199A3 (en) | 2008-09-18 |
| WO2008094199A9 (en) | 2008-11-13 |
| AU2007345770B2 (en) | 2011-05-26 |
| CA2659403C (en) | 2014-10-28 |
| JP2009544445A (en) | 2009-12-17 |
| US7651458B2 (en) | 2010-01-26 |
| CN101516432A (en) | 2009-08-26 |
| EP2046438B1 (en) | 2012-09-26 |
| CA2659403A1 (en) | 2008-08-07 |
| AU2007345770A1 (en) | 2008-08-07 |
| EP2046438A4 (en) | 2010-09-15 |
| WO2008094199A2 (en) | 2008-08-07 |
| US20070027352A1 (en) | 2007-02-01 |
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